It is estimated that 50 million people in the United States
suffer from varicose veins. Varicose veins can be a cosmetic
problem, an annoyance, or a more serious medical problem affecting
lifestyle and the ability to perform normal daily activities.
These elongated, dilated, tortuous, and painful veins most often
occur in the lower extremities.

Did you know that the vast majority of vein problems can be
successfully treated with non-surgical office based procedures?
Dr. Charles M. Sheaff, MD was among the first in the Chicagoland
area to use EVLT to treat saphenous vein reflux, and
he now brings this and other advanced techniques to Jacksonville.

Currently, most patients who have varicose veins caused by an
abnormal saphenous vein are treated with this safe, effective,
relatively painless procedure. It is performed in a convenient,
comfortable and private office setting.

Dr. Sheaff brings over 20
years of experience in treating varicose veins to his practice in
Jacksonville. His private practice in Schaumburg, Illinois treated over 5,000
cases of varicose veins over the years.

Varicose veins can be more than an unsightly annoyance - they
can be a serious medical condition requiring medical treatment.

The problem of varicose veins can be attributed in large part
to the erect posture of the human animal, which places tremendous
hydrostatic pressure on the veins in our legs.

At regular intervals inside the tubular structure of the veins
of the leg are tiny valves that force the blood to flow upward
toward the heart. When one of the valves "blows," pressure on
the valve below it is increased, making it more susceptible to
damage - a kind of cascading effect. When one or more of these
valves are damaged, a varicose vein results.

The symptoms vary, depending on the severity of the condition.
The most common medical indication, however, is a deep, cramp-like
pain in the legs which is aggravated by standing up for prolonged
periods of time. The pain is usually gone in the morning, since
lying down decreases the pressure in the leg veins and thus relieves
the pain. Those who have varicose veins may also notice swelling
of the leg and skin changes, including rashes or a rusty-colored
discoloration of the skin. Symptoms may also be worse during warm
weather, during a woman’s menses, or during exercise. Some women
report pain during sexual activity.

Venous Stasis Ulcers

Once ulcers, or sores in the skin occur, treatment becomes more
pressing. Venous stasis ulcers usually occur around the ankle in
skin damaged by long standing high venous pressure. A relatively
minor injury is often the precipitating event. We recommend topical
treatment for the ulcers while the doctor works to correct the venous
insufficiency.

Spider Telangiectasia

Although these small surface veins can produce symptoms such as
burning and itching, treatment is usually considered cosmetic.
Many treatment modalities are available including topical creams,
electrotherapy, injections, and laser therapy. Considering expense,
effectiveness, discomfort, and invasiveness, we feel that injection
therapy with a series of simple office procedures is usually the
best to treat Spider Telangiectasia.

What Causes Varicose Veins?

The usual cause is an inherited tendency toward weak valves, but
the condition can be aggravated by anything that increases abdominal
pressure, including pregnancy, heavy lifting, chronic constipation
or an upper respiratory problem which results in severe coughing.

How Are Varicose Veins Treated?

Treatment of varicose veins should be tailored to the individual’s
anatomic and physiologic specifics. In general, treatment is
directed at preventing reflux in the long and/or short saphenous
veins (the primary surface veins running down the leg) and at
destroying the branch varicosities. Each may be accomplished by
either removal or ablation. Some of the methods are discussed
below.

Compression Garments

In order to be effective, compression garments should provide at
least 20-30 mmHg pressure at the ankle with graded compression
gradually decreasing up the leg. Higher pressure may be needed
for more serious venous disorders resulting in edema and
ulcerations. Wearing compression garments may delay progression
of disease or at least provide a level of comfort. They will not
reverse existing varicose veins or venous insufficiency.

EVLT (Endovenous Laser Treatment)

If high venous pressure from an abnormal long or short saphenous
vein is contributing to varicose veins, then the saphenous vein
should be addressed first, which traditionally meant a vein stripping.

EVLT (Endovenous Laser Treatment) was developed as a less invasive
way to ablate the abnormal long or short saphenous vein without
a major operation. It is an effective alternative to stripping.
For the long saphenous vein (the most common problem), a catheter
is inserted in the vein near the knee using ultrasound guidance
and through a tiny puncture wound. Also using ultrasound guidance,
the catheter tip is positioned near the saphenofemoral junction
and the laser fiber is inserted.

A specialized tumescent local anesthesia procedure is used and the
laser is activated and the fiber gradually withdrawn. The connective
tissue in the wall of the vein is altered, and as a result, the vein
heals shut or is ablated. This relatively non-invasive office procedure
takes less than an hour and is successful in greater than 95% of cases.

Normal activities are resumed immediately, although there is often some
aching and a feeling of tightness for a week or two. Deep vein
thrombosis, or a clot in the deep vein, is a risk with EVLT or surgical
stripping, but is exceedingly rare (less than 1% in our experience).
Also, whenever the long saphenous vein is removed or altered, one must
consider that it is one conduit used for heart bypass that would no
longer be available.

Injection Sclerotherapy (Phlebosclerosis)

A common method of treating varicose veins today is to inject a
sclerosing chemical into the vein, destroying its lining. The injection
is guided by direct vision, palpation, or ultrasound. The leg is then
bandaged tightly for a period of time, allowing the vein to heal shut.
Several treatments are usually necessary. The method is primarily for
branch varicosities, but with sequential injections, it can be used to
ablate the saphenous vein.

The Injection Sclerotherapy (Phlebosclerosis) treatment is usually not
completely effective in closing the varicose vein along its entire length.
Pockets may remain, trapping a bubble of blood as a tender lump. This
trapped blood can be aspirated, or if left alone, the body will eventually
resorb it and it will go away. Sometimes skin stains will appear as
stagnant blood leaches out of the vein. These are simply a cosmetic problem
and will fade over several months. Serious complications are very unusual.
Allergic reactions to the chemical are extremely rare. Occasionally, some
of the chemical may leak out of the vein, causing a small chemical burn
which will heal slowly, leaving a small scar.

Surgical Stripping

In the past, the gold standard for treating larger varicose veins
was stripping, or surgical removal of the affected vein. That's
still a viable option in some situations, depending on the extent
of the disease and the underlying pathophysiology.

Both the saphenous vein and branch varicosities may be stripped.
Stripping of the long saphenous vein involves a 1–2 inch incision
in the upper thigh or groin area and a 1/2 inch incision in the
area of the knee. The vein is removed by pulling it out from above
with an inversion technique. The saphenous vein in the lower leg is
usually not stripped except in cases with particularly advanced disease.

The branch varicosities are removed through a series of small puncture
wounds placed along the length of the visible vein. Hook avulsion and
other mini-invasive techniques are used so that the incisions are quite
small. However, several incisions are still needed, and the procedure
is tedious for the surgeon, and it is difficult to achieve complete removal.

While surgical stripping is the most invasive treatment method, it is also
the most effective. Areas of bruising, swelling, and numbness are common,
but are temporary. A compression wrap is applied and left in place for 2–4 days.

SEPS (Subfascial Endoscopic Perforator Surgery)

Large dilated surface veins and ulcers are occasionally related to damaged
valves in the veins that connect the deep and surface systems. Interruption
of these perforating veins to prevent pressure buildup used to be a complex
procedure with considerable morbidity. Our vein care specialists are trained
in SEPS (Subfascial Endoscopic Perforator Surgery), which is a mini-invasive
procedure where these abnormal perforating veins are interrupted through
small puncture wounds using videoscopic technique.

Before & After Examples

Frequently Asked Questions

Which Approach Is Best?

No single approach is best for everyone. That is precisely why
we offer a multidisciplinary approach with several treatment
options. At one end of the spectrum, injection therapy is a
simple office procedure but may require several treatments
and may not prevent future recurrence. At the other end,
full surgical stripping is the most invasive, but offers
the most durable solution with a single procedure. The
advent of EVLT has allowed us to treat even the most severe
disease in an office setting without major surgery. Often,
a combination of methods is appropriate.

The best approach is dictated by each individual’s anatomy,
physiology, lifestyle, and other medical conditions. Each
form of treatment has its advantages. The injection method
is less expensive than stripping, but it may involve as many
as two dozen return visits to the doctor. And only one leg
can be done at a time.

With stripping, both legs can be treated at once, and the treatment
is complete after one session in surgery and one visit to the surgeon's
office for removal of the stitches. Generally, too, in patients
who have recurring problems with varicose veins, stripping is a
more effective treatment that lasts longer.

Does Wearing Support Hose Help?

Patients with bad varicose venous disease can improve the circulation
in their legs by wearing heavy-duty surgical stockings that effectively
compress the veins so they are not carrying blood. In patients prone
to recurrence of the problem, wearing these stockings as much as
possible will delay another episode. If it were possible to wear
them all the time, it would even prevent the problem.

But a word of caution: support hose are not going to take the
veins out of circulation unless they are providing a fair amount
of pressure. The so-called support hose that are available at
hosiery counters won't do it; real support hose must be purchased
from a store that carries medical/surgical supplies.

Support hose are rated by the numbers of millimeters of mercury
pressure applied at the ankle. The pressure should be at least 25
millimeters to do any good. Hose are available in pressures up to
80 millimeters, but you'd probably need a crowbar to get those on!
The rated pressure should be shown on the box - if not, you can
be sure it's less than 25 millimeters and you might as well save
your money.

What About Spider Veins?

Spider veins are small veins very close to the surface of the
skin. They often occur over larger varicose veins, but other causes
can include trauma or too-tight girdles or hosiery. They occur more
often in women than in men.

Treatment of spider veins is usually done for cosmetic reasons.
There are several approaches. Spiders can be treated with a laser,
but this is very expensive, ranging from $300 to $400 per session,
and sometimes requiring as many as five or six sessions. Spider
veins can also be injected with a sclerosing chemical, like larger
varicose veins, or destroyed with electric current. If the spiders
are small, all these methods will work well without leaving a
blemish.

However, the treatment we prefer is the injection of a concentrated
salt solution. This works more slowly, but the spiders just slowly
shrivel and disappear over three to four weeks. Another advantage
is that, with this technique, there is less chance for skin stains.

What if Deep Veins of the Leg are Involved?

When the valves in the deep veins are gone, stripping or sclerosing
the superficial veins will not be beneficial.

But some experimental techniques to put new valves in the deep
veins are being tried to manage cases when there are serious medical
problems, such as recurrent ulcerations at the ankle. These usually
involve taking a valve out of a vein in the arm and transplanting
into the leg. The success rate so far is only about 50%.